title: Induction of systemic bone changes by preconditioning total body irradiation for bone marrow transplantation.
abstract: BACKGROUND
  Preconditioning total body irradiation (TBI) prior to bone marrow transplantation (BMT) has been believed to be a safe procedure that does not cause late morbidity; yet, a recent report raises the suspicion that TBI-induced chondroosseous abnormalities do occur.
  
  
  OBJECTIVE
  To evaluate the radiological manifestations of TBI-induced skeletal alterations and their orthopaedic morbidity.
  
  
  METHODS
  Subjects included 11 children with TBI-induced skeletal changes, including 9 in our hospital and 2 in other hospitals. The former were selected from 53 children who had undergone TBI with BMT. Radiographic examinations (n=11), MRI (n=3), CT (n=2), and medical records in the 11 children were retrospectively reviewed.
  
  
  RESULTS
  The skeletal alterations included abnormal epiphyseal ossification and metaphyseal fraying (8/11), longitudinal metaphyseal striations (8/11), irregular metaphyseal sclerosis (6/11), osteochondromas (4/11), slipped capital femoral epiphysis (2/10), genu valgum (3/10), and platyspondyly (2/3). MRI demonstrated immature primary spongiosa in the metaphysis. Of the 11 children, 9 had clinical symptoms.
  
  
  CONCLUSIONS
  TBI can induce polyostotic and/or generalized bone changes, mainly affecting the epiphyseal/metaphyseal regions and occasionally the spine. The epi-/metaphyseal abnormalities represent impaired chondrogenesis in the epiphysis and growth plate and abnormal remodelling in the metaphysis. Generalized spine changes may lead to misdiagnosis of a skeletal dysplasia.
authors.affiliation: Department of Radiology, National Centre for Child Health and Development, 2-10-1 Okura, Seatagaya-ku, Tokyo 157-8535, Japan. osamu-m@rc4.so-net.ne.jp
authors.forename: Osamu
authors.initials: O
authors.lastname: Miyazaki
authors.forename: Gen
authors.initials: G
authors.lastname: Nishimura
authors.forename: Reiko
authors.initials: R
authors.lastname: Okamoto
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Masaki
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kumagai
authors.forename: Yoko
authors.initials: Y
authors.lastname: Shioda
authors.forename: Kumiko
authors.initials: K
authors.lastname: Nozawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kitoh
mesh_terms: D000293:Adolescent; D001847:Bone Diseases / Q000175:diagnosis* / Q000209:etiology*; D016026:Bone Marrow Transplantation; D001842:Bone and Bones / Q000528:radiation effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D019172:Transplantation Conditioning / Q000009:adverse effects* / Q000379:methods; D014916:Whole-Body Irradiation / Q000009:adverse effects*